Home nurses play indispensable role in long-term care

Kellie Bramlet

Monday

Nov 30, 2009 at 12:01 AMNov 30, 2009 at 6:35 PM

Janice Bragg didn’t like the way her husband was being cared for in a nursing home. She said she figured she could do better, and with the help of two nurses from Western Illinois Home Health Care she feels she has. But she couldn’t do it without them.

Janice Bragg didn’t like the way her husband was being cared for in a nursing home.

She said she figured she could do better, and with the help of two nurses from Western Illinois Home Health Care she feels she has. But she couldn’t do it without them. “You just don’t know how much they help,” she said. Bragg’s husband can no longer walk and must be fed through a feeding tube.

“He’s good in the morning and he knows me, and in the afternoon he doesn’t,” she said.

Bragg said she’s 72 and in good health, so there’s a lot she can handle around the house, but there are things she still struggles with. The most helpful service the nurses provide is bathing Bragg’s husband, but she said she can depend on them for almost anything. She’s called them with questions, problems and small emergencies, and always received a quick response. “It doesn’t make any difference if it’s a holiday or not,” she said.

Bragg and her husband are just one of 1,355,300 patients and their families who subscribe to home health care services in the United States, according to a 2000 survey by the U.S. Centers for Disease Control and Prevention.

Each November, the health care industry acknowledges those who work in home health care and hospice. The doctors, nurses and volunteers travel to up to eight homes a day, providing medical assistance and helping out around the home. They spend hours visiting, answer phone calls with questions and tend to emergencies.

It takes a certain set of skills to work in home health care and hospice, leaders of local health care providers said.

“It’s what we call the home health and hospice heart,” said Donna Medina, vice president of OSF Home Care Hospice Services. “It’s the feeling like they can really make a difference helping (patients) stay in their homes. I don’t think you’ll find any more caring individuals.”

Lynn Kitterman, administrator of Midwest Regional Home Care, a Cottage Hospital affiliate, said the caregivers work hard to meet the individual physical and emotional needs of each patient.

“They must realize the importance of practicality, attentiveness and timeliness and understand their patients have the right to maintain as much independence and privacy as possible,” she said. “Patience, compassion, tact and a sense of humor are all vital qualities.”

Months ago, not long after the Cooks moved into the supported living residences in WoodRidge Supportive Living Residence and registered for home care from Spoon River Home Health Care, Evelyn fell and broke her ankle.

Initially, home care nurses visited the Cooks three times a week. Now that Evelyn’s strength is up and she’s moving with the aid of a walker, the nurses only come once a week to check on the couple. After spending about an hour with them, the two nurses hop in their red Mini Cooper marked with Spoon River Home Health Care’s logo and slogan, “Bridging the gap in health care” on the back windows and drive to the next patient’s home.

It’s typical for nurses to visit six to eight patients a day, Platt said. Platt, co-owner of Spoon River Home Health Care, founded the company 18 years ago. A native of the area, Platt had been working as a traveling nurse in Florida, when she decided to move back. She liked the lifestyle she had had working with people in their homes and knew a great deal about home care since it had been so prevalent in Florida. She wondered how people in the Spoon River area received home care. At the time, there weren’t nearly as many home care providers as there are now. So she set out to establish one in central Illinois, geared especially toward those living in rural locations. That’s what the slogan, “Bridging the gap in health care,” refers to, she said.

Bridging the information gap

As leaders of local health care service companies mentioned, part of the home health care and hospice workers’ job is to promote home health care. Home health care and hospice services are somewhat new relative to other forms of care. (A 1981 survey showed 18 percent of the public knew what home care was.) While the industry has worked to better establish and promote itself, it’s still not an idea most patients’ minds jump to when first diagnosed.

“They think they have to be really, really sick to A, qualify, and B, to benefit,” Medina said. The reality is that many patients who receive home health care are not elderly or facing life threatening illnesses. According to the CDC survey less than half of the patients who receive home health care are older than 65.

Home care is covered by most private insurance companies, Medicaid and Medicare, but in order to qualify for Medicare coverage patients must be home-bound. That doesn’t mean patients must literally be unable to leave the house though, Kitterman explained. It means it must be infrequent and a “taxing effort” when patients do leave the house. Kitterman said home care should be administered on a case-by-case basis.

“Many people correlate home care as a benefit they receive after being in the hospital for a surgery, a fall or some other significant event,” Kitterman said. “This is true, but there are also so many other things we can do for them.”

Hospice, on the other hand, is available to patients with a life-limiting illness, but that, too, encompasses a larger scope than people may think.

“Anyone diagnosed with a terminal illness can be eligible for hospice. It is not just for cancer, but also for end-stage heart and lung disease, kidney failure, AIDS, Alzheimer’s, etc.,” OSF’s Web site explains. These patients have decided not to pursue life-prolonging treatment and instead opt for treatment that focuses on comfort.

Some patients of either home care or hospice need help taking their medications, some have weakened immune systems and have been told they shouldn’t enter a hospital and risk a potential infection. Some are young athletes who have been injured and need physical therapy in their homes. But they all seem to agree that they’d rather receive care in their own homes than in the hospital.

“It’s a whole different world in the hospital than in a home,” Medina said.

Often in the home family members take on different roles. A sibling, spouse, son or daughter can become a nurse.

“Families are asked to do things that used to be done by professionals,” said Barb Beyers, director of Western Illinois Home Care, a Monmouth-based home care provider.

Family members can insert IVs, administer physical therapy and serve as the nurses’ eyes and ears when they aren’t there.

“It’s just amazing what they can learn and they can do,” Platt said.

And it’s not just nurses and family members who help take care of home care and hospice patients. Many of the caretakers are volunteers.

About 250 volunteers dedicate their time to OSF’s hospice patients, Medina said. Last year they donated more than 11,000 hours of service. And they did more than just provide the patients with medical care. They purchased school supplies for patients’ children, delivered baskets of food to patients for Thanksgiving, and helped the faraway family members of hospice patients buy plane tickets to say a last goodbye. Like most area home health care providers, OSF employees pride themselves on belonging to the mission-driven organization.

“We really go the extra mile for our patients,” Medina said.

She said employees once set up a video conference for a patient whose husband had been incarcerated. They wheeled her bed out to the parking lot where they had set up the telecast so the two could talk. After the couple said their last good-byes, they brought the patient back inside. An hour later she passed away.

Platt agreed.

“Some of the things we pull off are pretty amazing."

She said she witnesses the benefits of home health care each day. Study after study shows that patients are more likely to heal faster in the home. They’re not around so many sick people, so there’s less exposure to germs, which means less chance of infections, she explained.

“When you go into the hospital life pretty much stop,” she said.

Restoring routine

Part of the goal of home health and hospice care is to return patients to the normalcy of their daily lives as quickly as possible.

Twice a week OSF Hospice nurses visit the home of Wanda and Ernie Higgins. They help Wanda with the cleaning, cooking and laundry, as well as checking on her blood pressure and breathing. Wanda breathes with the help of an oxygen tank. She walks with the assistance of a walker. And she and her husband are able to continue living in their home thanks to hospice care.

“It helps us be here instead of in a nursing home,” Wanda said. “There’s a time when nursing homes are necessary, but I’m very thankful to be in my home.”

If Wanda would have moved into a nursing home, Ernie would have moved in with her. Ernie, who turns 101 this month, still works at Hy-Vee, about 16 hours a week. Assuming the weather conditions are on their side, Wanda drives Ernie to work. He handed in his driver’s licence on his 100th birthday. Although he hadn’t had an accident in 50 years, he said he figured it was about time.

Cindi Peck, a volunteer coordinator with OSF Hospice, said they encourage their patients to stay as active as possible.

Wanda started hospice care in January after her doctor recommended it to her. While Wanda’s physical health has stayed about the same since she enrolled in hospice care, she said she does feel better. With the nurses’ help around the house she’s not trying to do things that exhaust her. And she’s not worried about her medication or walking more than she should be. She added: “There’s more of a free feeling of the life that you can have with help.”

Kellie Bramlet can be reached at kbramlet@register-mail.com.

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